Neonatal Stabilization Score (NSS)

Measures:

(1) vital signs

(2) laboratory investigations

(3) respiratory support

(4) IV fluid administration

(5) specific management

after Table 1, page 181

where:

• Complete vital signs: temperature, heart rate, respiratory rate, blood pressure.

• Complete laboratory studies: hematocrit, blood glucose, sepsis workup if indicated, chest X-ray if in respiratory distress.

• Indications for sepsis workup: maternal fever, mother on antibiotics, prolonged rupture of the membranes for > 24 hours.

• Sepsis workup: blood, urine and CSF cultures (or attempt at lumbar puncture).

• Appropriate respiratory support: (a) no respiratory distress and no action taken; (b) respiratory distress treated adequately with oxygen and respiratory support

• Indications for supplemental oxygen: mild respiratory distress and/or when PaO2 < 50 mm Hg.

• Indications for more than supplemental oxygen: moderate or severe respiratory distress and/or when PaCO2 > 50 mm Hg.

• Inappropriate fluid administration: fluid containing electrolytes during the first day, D10W when dextrostix > 175 mg%; D5W when dextrostix < 25 mg%; blood transfusion not administered for a patient is in respiratory distress and the hematocrit is < 40%.

• Adequate fluid maintenance rate: 80 – 100 mL/kg/day in the first day of life.

• Specific management includes administration of antibiotics, placement of catheters, chemical resuscitation, and treatment of shock.

• Administration of antibiotics: indicated for any patient in whom systemic cultures were done, when there is a history of maternal fever. or possible infection in the infant.

• All infants with an endotracheal tube were felt to need an umbilical artery catheter.

• Chemical resuscitation: administration of sodium bicarbonate when acidosis is stated or blood pH < 7.25 with PaCO2 < 50 mm Hg.

• Management of shock include transfusion of plasma expanders.

neonatal stabilization score =

= SUM(points for all 5 measures)

Interpretation:

• minimum score: 0

• maximum score: 10

• The higher the score, the better stabilized the neonate was prior to transport. A score of 10 indicates excellent stabilization.

• In evaluating performance, a NSS < 6 was considered low.

Performance:

• Interrater agreement on chart review was good, with Kappa 0.76.